Irfan Ahmed | Robert Gordon University (original) (raw)

Papers by Irfan Ahmed

Annals of the Royal College of Surgeons of England, Mar 1, 2010

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Although traditional quality measures such as morbidity and mortality outcomes still pay an impor... more Although traditional quality measures such as morbidity and mortality outcomes still pay an important role in the assessment of health care quality, greater emphasis is now being placed on patient-reported outcome measures such as patient satisfaction. This area is especially important for novel surgical technologies such as single-incision laparoscopic surgery (SILS) and natural orifice translumenal endoscopic surgery (NOTES). These new innovations are able to minimize or abolish surgical scarring and are likely to have most benefit in the area of patient satisfaction as opposed to traditional outcome measures. Therefore, it is important to gauge the public opinion regarding these new techniques, as continued public interest can help support further research in this up-and-coming field. A questionnaire study was carried out with members of the general public. Questions were asked regarding preference for surgical techniques, including open surgery, laparoscopic surgery, NOTES, and SILS, in the situation of acute appendicitis. The questionnaire was completed by 1006 individuals. Results indicated that an established safety profile was necessary before the introduction of these new techniques into general practice. The concept of scarless surgery did appeal to the public, with SILS being the treatment of choice in the scenario of acute appendicitis. The patient perspective on health care is an important aspect of health care quality assessment. This is especially important with regard to the development of novel surgical techniques such as SILS and NOTES. With these techniques, the potential benefits are most likely to be found in the realms of reduced scarring and improved patient satisfaction. The findings from this study demonstrate the public&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s interest in these new techniques and thus give further support to continued research and development in this area.

The American Journal of Surgery, 2012

BACKGROUND: Laparoscopic liver resection is increasingly being used for the excision of benign an... more BACKGROUND: Laparoscopic liver resection is increasingly being used for the excision of benign and malignant hepatic lesions. The aim of this study was to perform meta-analysis on the compiled data from available observational studies. METHODS: All the studies comparing laparoscopic versus open liver resections were searched on the available databases. Data were analyzed using Review Manager software version 5.0 (The Cochrane Collaboration, Software Update, Oxford, UK). RESULTS: There was a total of 2,466 patients: 1,161 (47.1%) in the laparoscopic group and 1,305 (52.9%) in the open group. The laparoscopic group was associated with a reduced overall complication rate (odds ratio ϭ .35; 95% confidence interval [CI], .28 -.45; P Ͻ .001; heterogeneity (HG): P ϭ .51), fewer positive resection margins for malignant tumor resections (odds ratio ϭ .38; CI, .20 -.76; P ϭ .006; HG: P ϭ .52) and a decrease in the number of patients requiring blood transfusion (odds ratio ϭ .36; CI, .23-.74; P Ͻ .001; HG: P ϭ .30).

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2012

Recent advances in minimally invasive surgery have centered on reducing the number of incisions r... more Recent advances in minimally invasive surgery have centered on reducing the number of incisions required, which has led to the development of the single-incision laparoscopic technique. A panel of European single-incision laparoscopy experts met to discuss the current status of, and the future expectations for, the technique. The experts reached agreement on a number of statements and recommendations, which will support surgeons in adopting the technique. The panel agreed that the single-incision technique may offer a number of benefits to patients; however, further clinical data need to be published to confirm its value. An ideal training route for surgeons who are adopting the technique was agreed upon, as was the need for a single, large clinical registry of data.

Surgical Endoscopy, 2011

Laparoscopic liver resection was first performed by Gagner in 1992. In the following years, lapar... more Laparoscopic liver resection was first performed by Gagner in 1992. In the following years, laparoscopic left lateral liver resection rapidly gained the interest of hepatobiliary surgeons due to the easy accessibility of the left lateral segment. This study aimed to gather and analyze available data from the observational studies that have compared laparoscopic and open left lateral hepatic resections. All the studies comparing laparoscopic and open left lateral liver resections were searched on the available databases including Medline, Ovid, Embase, Pubmed, and the Cochrane database. The latest date for the search was 30 January 2010. All the articles were cross-references. The studies comparing left lateral liver resections were included in the metaanalysis. Data was analyzed using Review Manager software version 5.0. After the literature search, a total of seven studies were included in the metaanalysis, which involved 245 patients: 134 in the laparoscopic group and 111 in the open group. The laparoscopic group was shown to have a lower overall complication rate (0.36; 95% CI, 0.20-0.68) and shorter operative time (48.07 min; 95% CI, 30.93-65.21 min) than the open group (p=0.001), which were not associated with heterogeneity between the studies (p=0.84 and 0.34, respectively). The hospital stay of the laparoscopic group was 4.52 days shorter (95% CI, -8.03 to -1.02) than that of the open group. This difference was significant (p=0.01) but associated with significant heterogeneity between the studies. Although no randomized controlled trials have compared open and laparoscopic liver resection, this metaanalysis demonstrated that laparoscopic left lateral resection is a safe and feasible option associated with a reduced overall complication rate. The authors conclude that it should be performed routinely in liver centers.

Catheterization and Cardiovascular Interventions, 2011

Transhepatic cardiac catheterization is now a well-established alternative when conventional veno... more Transhepatic cardiac catheterization is now a well-established alternative when conventional venous routes for cardiac access have failed. Some operators prefer this route even routinely, due to the direct access that it offers to the right atrium and atrial septum. We report the case of a newborn baby previously operated on for infradiaphragmatic total anomalous pulmonary venous drainage who represented with right sided pulmonary vein stenosis. Transhepatic portal vein access, first reported here, gave direct access to the right upper pulmonary vein, through the patent descending vein, after the conventional transfemoral venous and retrograde arterial routes had failed.

Assessment for Effective Intervention, 2001

... Brenda Smith Myles University of Kansas ... The impor-tant area of assessing joint attention ... more ... Brenda Smith Myles University of Kansas ... The impor-tant area of assessing joint attention in chil-dren and youth with ASD is discussed by Peter Mundy and Amy Vaughan, who give a concise overview of the nature of joint atten-tion and its importance for social and com ...

2-3 the patient must be informed clearly and counselled about options of home-based palliation.

El Mednifico Journal, 2014

Minimally invasive techniques have revolutionized surgery, reducing post-operative morbidity and ... more Minimally invasive techniques have revolutionized surgery, reducing post-operative morbidity and hospital stay by reducing abdominal wall trauma. There is also a significant cosmetic advantage with these newer techniques. Minimally invasive surgery has opened the floodgates of innovation as surgeons open up to possibilities of new instrumentation and techniques different from those practiced for centuries.

World Journal of Surgery, 2008

Background

Trials, 2012

Background: Laparoscopic surgery has become the preferred approach for many procedures because of... more Background: Laparoscopic surgery has become the preferred approach for many procedures because of reduced post-operative pain, better recovery, shorter hospital stay and improved cosmesis. Single incision laparoscopic surgery is one of the many recent variants where either standard ports or a specially designed single multi-channel port is introduced through a single skin incision. While the cosmetic advantage of this is obvious, the evidence base for claims of reduced morbidity and better post-operative recovery is weak. This study aims to compare the effectiveness of single port/incision laparoscopic appendicectomy with standard three-port laparoscopic appendicectomy in adult patients at six weeks post-surgery. We also wish to assess the feasibility of a multicentre randomised controlled trial comparing single port/incision laparoscopic surgery with standard three-port laparoscopic surgery for other surgical techniques.

Surgical Endoscopy, 2009

Laparoscopic appendectomy is one of the most commonly performed minimally invasive surgeries worl... more Laparoscopic appendectomy is one of the most commonly performed minimally invasive surgeries worldwide. In recent years, successful attempts to reduce the number of the traditionally used three ports have been reported. Specifically, two-port techniques, hybrid approaches, and single-port assisted techniques have been described. In this case series, the author describes for the first time a successful and uncomplicated true single-port appendectomy (TSPA) technique. Between July and December of 2007, 14 consecutive patients were assigned to undergo TSPA for presumed appendicitis at Yale-New Haven Hospital. The novel approach involves an innovative &amp;amp;amp;quot;puppeteer technique,&amp;amp;amp;quot; which uses a &amp;amp;amp;quot;pulley&amp;amp;amp;quot; in the form of an intraabdominally placed loop to the abdominal wall as an axle to elevate the appendix with a string. The thread is pulled by the surgeon extracorporeally, similar to a puppeteer moving the limbs of his or her puppets. Of the 14 patients, 13 (8 women and 5 men) underwent a successful TSPA. One patient was converted to a two-port appendectomy. The average age of the patients was 37.5 years (range, 22-59 years), and the average body mass index (BMI) was 27.4 kg/m(2) (range, 19.4-39 kg/m(2)). The mean operative time was 87.5 min (range, 54-128 min). No major complications were observed. One minor postoperative complication occurred, involving urinary retention, which resolved within 24 h. The novel &amp;amp;amp;quot;puppeteer technique&amp;amp;amp;quot; seems to be a safe and easily reproducible alternative to previous laparoscopic appendectomy techniques. It uses only one single 11-mm port without any additional skin incisions or transdermally traversing needles. It is performed entirely intracorporeally, resulting in presumably less postoperative pain and improved cosmesis. Randomized controlled trials are necessary to investigate this novel technique. The TSPA technique, the first of its kind in the treatment of appendicitis, minimizes the minimally invasive approach to a new level.

Surgical Endoscopy, 2012

Background Surgical smoke containing potentially carcinogenic and irritant chemicals is an inevit... more Background Surgical smoke containing potentially carcinogenic and irritant chemicals is an inevitable consequence of intraoperative energized dissection. Different energized dissection methods have not been compared directly in human laparoscopic surgery or against commonly encountered pollutants. This study undertook an analysis of carcinogenic and irritant volatile hydrocarbon concentrations in electrocautery and ultrasonic scalpel plumes compared with cigarette smoke and urban city air control samples. Methods Once ethical approval was obtained, gas samples were aspirated from the peritoneal cavity after human laparoscopic intraabdominal surgery solely using either electrocautery or ultrasonic scalpels. All were adsorbed in Tenax tubes and concentrations of carcinogenic or irritant volatile hydrocarbons measured by gas chromatography. The results were compared with cigarette smoke and urban city air control samples. The analyzing laboratory was blinded to sample origin. Results A total of 10 patients consented to intraoperative gas sampling in which only one method of energized dissection was used. Six carcinogenic or irritant hydrocarbons (benzene, ethylbenzene, styrene, toluene, heptene, and methylpropene) were identified in one or more samples. With the exception of styrene (P = 0.016), a nonsignificant trend toward lower hydrocarbon concentrations was observed with ultrasonic scalpel use. Ultrasonic scalpel plumes had significantly lower hydrocarbon concentrations than cigarette smoke, with the exception of methylpropene (P = 0.332). No significant difference was observed with city air. Electrocautery samples contained significantly lower hydrocarbon concentrations than cigarette smoke, with the exception of toluene (P = 0.117) and methyl propene (P = 0.914). Except for toluene (P = 0.028), city air showed no significant difference. Conclusions Both electrocautery and ultrasonic dissection are associated with significantly lower concentrations of the most commonly detected carcinogenic and irritant hydrocarbons than cigarette smoke. A nonsignificant trend toward lower hydrocarbon concentrations was seen with ultrasonic scalpel dissection compared with diathermy. The contamination levels in city air were largely comparable with those seen after ultrasonic scalpel use. Although hydrocarbon concentrations are low, cumulative exposures may increase health risks. Where concerns arise, ultrasonic scalpel dissection may be preferable.

Journal of the Royal Society of Medicine, 2005

Journal of Laparoendoscopic & Advanced Surgical Techniques, 2012

Single-port/incision laparoscopic appendectomy (SPILA) is a modern advancement toward stealth sur... more Single-port/incision laparoscopic appendectomy (SPILA) is a modern advancement toward stealth surgery, using a single point of entry. Despite the paucity of clinical data, it is increasingly being used to minimize scarring and, potentially, pain associated with the multiple entry points. We aimed to summarize and present available data on this new approach. All available databases until December 2010 including the Cochrane Controlled Trials Register, MEDLINE, and EMBASE were searched and cross-referenced for studies describing single-incision laparoscopic appendectomy. Case and experimental reports, series with fewer than 5 patients, and non-English articles were excluded. Outcome measures were operative time, postoperative hospital stay, pain scores, complications, conversion, and mortality, stratified according to type of SPILA approach. SPSS version 18.0.0 software was used for data collection. Database query yielded 79 articles; 45 were included (1 randomized controlled trial, 44 case series). Total cases were 2806, with mean patient age for studies ranging from 7.0 to 37.5 years. No mortality was reported. The overall complication rate was 4.13%. The overall weighted mean operating time was 41.3 minutes (range, 15.0-95.9 minutes). The weighted mean hospital stay was 2.79 days (range, 1.0-6.6 days). Although the incidence of complications with SPILA remains low and operating times between new and traditional approaches are comparable in case-based literature, adequately powered randomized trials are required to assess its effectiveness. Occurrence of long-term complication types remains unexplored.

International journal of surgery (London, England), 2013

Introduction: Single port/incision laparoscopic surgery (SPILS) is a recent innovation in minimal... more Introduction: Single port/incision laparoscopic surgery (SPILS) is a recent innovation in minimally invasive surgery whereby operations are performed through a single point of entry. Despite the relative paucity of clinical data, the procedure is increasingly being used to minimise scarring and pain associated with the multiple entry points of traditional laparoscopic surgery. This study aimed to analyse the awareness, experience and opinions of British surgeons regarding SPILS. Methods: Electronic, 13-item, self-administered, anonymous questionnaire survey distributed via national/regional surgical mailing lists and websites. Results were collated and analysed with SPSS v17.0 for Windows (SPSS, Inc, Chicago, IL). Results: 342 fully completed responses received, including 72 (21%) Consultants and 189 (55%) higher surgical trainees. Overall 330 (96.5%) were aware of SPILS; there was no significant difference in awareness between grades. Only 37% had assisted or performed SPILS procedures. More consultants performed these than trainees (56.3 vs 32.0%, p < 0.05). Operative experience was limited, with only 6% of those undertaking SPILS performing 25 procedures, and 60% performing 5. 61.4% believed SPILS takes longer to perform, and 32.8% believed it has higher complication rate. Factors cited as limiting uptake included: lack of evidence (70%), insufficient training opportunities (78%), incorrect instrumentation (70%), increased cost (62%), and hospital policy (44.5%). Patient preference was considered to have negatively affected SPILS uptake by only 9% of respondents. A greater proportion of trainees (94.6% vs 78.9%) felt there were insufficient SPILS training opportunities (p ¼ 0.001). Conclusions: Although awareness of SPILS is high, operative experience is limited and negative perceptions regarding operating time and complications remain. The findings suggest future uptake relies strongly on the availability of evidence, training, instrumentation and reduced costs. Scientific studies are still awaited to assess effectiveness and provide clinical and economic evaluation.

Background The face of surgery has changed over the past two decades with the introduction of lap... more Background The face of surgery has changed over the past two decades with the introduction of laparoscopic techniques. The majority of surgical specialties now perform minimally invasive procedures hence decreasing the scarring, pain, and infection historically associated with open surgery. To further reduce the invasiveness of surgery, new surgical techniques like Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single-Port Surgery (SPS) are under development. Despite investment from the medical device industry and enthusiasm from medical professionals, we must analyse patient preferences and expectations of these novel techniques. This analysis will help us establish the demand for such techniques and guide future resource allocation. Methods A questionnaire-based study was derived to identify whether the concepts of innovative techniques are acceptable to the general population. Their preferences between different available surgical options were recorded along with their choices for new innovative techniques. This study was carried out face-to-face and by using an online survey. It comprised four questions based upon a hypothetical scenario of an acute appendicitis. All the data were captured in a prospective database and analysed using statistical software.

Surgical endoscopy, 2013

Dear Editor,We read with interest the recent systematic review on survival training in single inc... more Dear Editor,We read with interest the recent systematic review on survival training in single incision laparoscopic surgery (SILS). The paper provides a timely and useful discussion on SILS training but did not note the differing opinions surrounding demand and benefits.A recent national survey conducted by our department [1] identified that despite widespread awareness and apparent interest amongst trainees and consultants, 74 % of respondents had no operative experience in SILS. The main issues identified in limiting further uptake were the lack of robust scientific testing (69.1 %) and insufficient training opportunities (77.9 %). The current evidence base exists mainly in the form of commentary and case series, although some randomised, controlled trials are now being published. While universal uptake of SILS procedures remains limited, these procedures are increasingly being used, despite this paucity of clinical data.We agree with the authors that appropriate training frameworks